1. GENERAL TEMPLATE FOR A 48”X36” POSTER Name(s) of Author(s) 1 ; Name(s) of Author(s) 2 ; Name(s) of Author(s) 3 1. Name of Institution; 2. Name on Institution; 3. Name of Institution Introduction Caring for patients’ oral health is an important part of a nurse’s role in patient care. It serves different purposes for patients, including that it is a comfort measure and reduces potentially dangerous oral flora that could lead to further medical complications such as ventilator-associated pneumonia (VAP). Oral health and interventions to maintain oral health will be described and shown to influence the prevention of VAP. Oral health cont. Saliva acts to maintain oral immunity through the mechanical removal of dental plaque and microorganisms that are present in the oral cavity. Saliva contains several immune mediators that actively fight against infections. Lactoferrin has been demonstrated to be an antibacterial agent that binds to iron in the body and prevents bacteria from replicating (Weinberg, 2001). IgA, an antibody found in saliva, functions to prevent microorganism attachment to the mucosa of the upper respiratory tract (O’Neal, Brown, & Munro, 2002). Critically ill individuals with reduced IgA have demonstrated an increased susceptibility to upper and lower respiratory tract infections (O’Neal et al., 2002). Safer Healthcare Now! (2007) proposed four key interventions in addition to oral health care, hand hygiene, and nutrition to prevent the development of VAP: (a) elevation of the head of bed greater than 30º: Research has demonstrated that patients in a supine position have a 34% incidence rate of VAP compared to 8% for those in a semirecumbent position (Drakulovic et al., 1999); Oral Health The oral cavity is the largest opening in the human body and can potentially be the access site for pathogenic organisms. The maintenance of a healthy oral cavity can prevent the acquisition of harmful microorganisms that can cause infections. The accumulation of dental plaque, oral microbial flora, and local immunity are three factors that influence oral health and the number of organisms in the oral cavity (Munro & Grap, 2004). Dental plaque is a collection of bacteria embedded in bacterial byproducts, salivary products, and food debris that attach to the hard surfaces of the teeth (Grap & Munro, 2004). Research has shown that within 48 hours of hospitalization, a critically ill patient’s normal flora changes to include virulent and pathogenic organisms, such as Methicillin-resistant Staphylococcus aereus and Pseudomonar aereus, that normally are not present (Grap & Munro, 2004). Oral Health Interventions The goals for oral health should focus on preventing the development of dental plaque and stimulating local immunity (Halm & Armola, 2009). Mechanical interventions include physically removing dental plaque by brushing the teeth and swabbing the mouth with foam swabs. Research has suggested that tooth brushing is the best method of removing dental plaque from the teeth and that foam swabs do not reduce the amount of dental plaque in oral cavities (Halm & Armola, 2009). Pharmaceutical interventions include the use of antibiotics or other antibacterial agents to reduce the colonization of bacteria in the oral cavity. Research on pharmaceutical interventions has shown that chlorohexidine is one of the best agents to reduce the colonization of oral flora and the incidence of lower respiratory tract infections in critically ill patients, compared to a placebo (Grap & Munro, 2004). Chlorohexidine, a broad- spectrum antibacterial agent, is preferred over other topic antibiotics because it has no resistance, whereas other antibiotics induce bacteria resistance (Halm & Armola, 2009). dfgfdgfdg heading On intensive care units many patients are intubated, which can increase the development of VAP. VAP is pneumonia that occurs in patients who have either a tracheostomy or an endotracheal tube, and the onset occurs after 48 hours of intubation (Grap & Munro, 2004; Safer Healthcare Now! 2007). Oral care is one factor that reduces a patient’s chance of developing VAP, which is important because ventilated patients who develop VAP have a higher mortality rate—46% compared to 32% of ventilated patients who do not have VAP (Ibrahim, Hill, Fraser, & Kollef, 2001). The health care system can currently save a minimum of $14,000 per patient if VAP is prevented (Safer Healthcare Now! 2007). This section is a basic summarization of oral care during a typical 12 ‑ hour shift. Once each shift, a nurse should assess the oral cavity, brush the teeth with a soft toothbrush, and rinse with chlorohexidine. Every two hours or as necessary, a nurse should moisturize the mouth, lubricate the lips, and remove oral secretions. Unit Policies (c) use of oral rather than nasal tubes to access the stomach and trachea: Nasotracheal and nasogastric tubes have an increased risk of sinusitis, which can potentially lead to VAP (Holzpfel et al., 1999); and (d) use of EVAC tubes for drainage of subglottic secretions: EVAC tubes are designed to remove pooled secretions above the endotracheal tube cuff, which can reduce the risk of aspiration and VAP (Safer Healthcare Now! 2007). (b) daily “sedation vacations” and assessment of readiness to extubate by performing spontaneous breathing trials: Research has shown that the length of mechanical ventilation can be decreased with daily weaning assessments (Safer Healthcare Now! 2007);